Human dignity in the Nazi era: implications for contemporary bioethics

Background: The justification for Nazi programs involving involuntary euthanasia, forced sterilisation, eugenics and human experimentation were strongly influenced by views about human dignity. The historical development of these views should be examined today because discussions of human worth and value are integral to medical ethics and bioethics. We should learn lessons from how human dignity came to be so distorted to avoid repetition of similar distortions. Discussion: Social Darwinism was foremost amongst the philosophies impacting views of human dignity in the decades leading up to Nazi power in Germany. Charles Darwin's evolutionary theory was quickly applied to human beings and social structure. The term 'survival of the fittest' was coined and seen to be applicable to humans. Belief in the inherent dignity of all humans was rejected by social Darwinists. Influential authors of the day proclaimed that an individual's worth and value were to be determined functionally and materialistically. The popularity of such views ideologically prepared German doctors and nurses to accept Nazi social policies promoting survival of only the fittest humans. A historical survey reveals five general presuppositions that strongly impacted medical ethics in the Nazi era. These same five beliefs are being promoted in different ways in contemporary bioethical discourse. Ethical controversies surrounding human embryos revolve around determinations of their moral status. Economic pressures force individuals and societies to examine whether some people's lives are no longer worth living. Human dignity is again being seen as a relative trait found in certain humans, not something inherent. These views strongly impact what is taken to be acceptable within medical ethics. Summary: Five beliefs central to social Darwinism will be examined in light of their influence on current discussions in medical ethics and bioethics. Acceptance of these during the Nazi era proved destructive to many humans. Their widespread acceptance today would similarly lead to much human death and suffering. A different ethic in needed which views human dignity as inherent to all human individuals

The Post-Research Ethics Analysis (PREA) Project

AUTHOR AFFILIATION: Dónal O'Mathúna, The Ohio State University, United States, and Dublin City University, Ireland, [email protected] series of presentations provide an overview of the PREA project and preliminary findings. An initial scoping review led to the Research Ethics Tool commissioned by the project funders, R2HC. Then a more thorough PREA Systematic Review was conducted, led by Mr Steven Martin of Anglia Ruskin University, UK. The methods and search results are presented, followed by an overview of the 13 Themes identified in the analysis. Then Prof Tine Van Bortel introduced the qualitative research component, beginning with the training for the in-country interviewers. Mr Nawaraj Upadhaya of HealthNet TPO discusses the coordination of the interviews in Nepal, Afghanistan and South Sudan. Dr Yimtu Mulate, Addis Ababa University conducted the interviews in Ethiopia. The qualitative analysis was discussed by Prof Van Bortel and Dr Ainul Hanafiah of the University of East London, UK. The methods of the analysis and the 10 Themes identified were presented, as well as overall conclusions from the findings

Surface neuromuscular electrical stimulation for quadriceps strengthening pre and post total knee replacement

Background Total knee replacement has been demonstrated to be one of the most successful procedures in the treatment of osteoarthritis. However quadriceps weakness and reductions in function are commonly reported following surgery. Recently Neuromuscular Electrical Stimulation (NMES) has been used as an adjunct to traditional strengthening programmes. This review considers the effectiveness of NMES as a means of increasing quadriceps strength in patients before and after total knee replacement. Objectives To assess the effectiveness of NMES as a means of improving quadriceps strength before and after total knee replacement. Search methods We searched The Cochrane Central Register of Controlled Trials (CENTRAL),MEDLINE (1950 to January week 1 2008), EMBASE (1980 to 2008 week 2), Cumulative Index to Nursing and Allied Health Literature (CINAHL)(1982 to 2007/11), AMED (1985 to Jan 2008), Web of Science, and Pedro (Jan 2008) (http://www.pedro.fhs.usyd.edu.au/index.html) for randomised controlled trials and controlled clinical trials. The electronic search was complimented by hand searches and experts in the area and companies supplying NMES equipment were also contacted. Selection criteria Randomised controlled trials and controlled clinical trials were accepted that used NMES for the purpose of quadriceps strengthening either pre or post total knee replacement. Data collection and analysis Two review authors decided which studies were suitable for inclusion based on the inclusion and exclusion criteria in the protocol and the data was extracted using pre-developed data extraction forms. Two review authors (BM and BC) independently assessed the methodological quality of the included trials using a descriptive approach as advocated by the Musculoskeletal group. Only two studies were included in the review. Neither study presented results in a form suitable for meta-analysis. The authors of both studies were contacted to obtain the raw data but they were no longer available. The data from both studies are described in the review. Main results Two studies were identified for inclusion in the review. No significant differences were reported in either study for maximum voluntary isometric torque or endurance between the NMES group and the control group but significantly better quadriceps muscle activation was reported in the exercise and neuromuscular stimulation group compared with the exercise group alone in the second study. This difference was significant at the mid training (six week) time point but not at the twelfth week post training time point. Further analysis of both studies were not possible due to the absence of raw data scores. Both studies carried a high risk of bias. Mean values were not given for strength, endurance, cross sectional area or quality of life. Pain outcomes, patient satisfaction or adverse effects were not reported in either study. The results were presented as percentage improvements from baseline and the number of subjects in each group was unclear. Authors’ conclusions The studies found in this review do not permit any conclusions to be made about the application of neuromuscular stimulation for the purposes of quadriceps strengthening before or after total knee replacement. At this time the evidence for the use of neuromuscular stimulation for the purposes of quadriceps strengthening in this patient group is unclear

Closing Remarks

AUTHOR AFFILIATION: Dónal O'Mathúna, The Ohio State University, United States, and Dublin City University, Ireland, [email protected] Nash, Director of the Center for Bioethics at The Ohio State University, and Dónal O'Mathúna bring the PREA conference to an add. They express gratitude to the participants, funders and staff who contributed to making the conference a success. They discuss plans for future related initiatives

Patient autonomy and choice in healthcare: Self-testing devices as a case in point

This paper aims to critique the phenomenon of advanced patient autonomy and choice in healthcare within the specific context of self-testing devices. A growing number of self-testing medical devices are currently available for home use. The premise underpinning many of these devices is that they assist individuals to be more autonomous in the assessment and management of their health. Increased patient autonomy is assumed to be a good thing. We take issue with this assumption and argue that self-testing provides a specific example how increased patient autonomy and choice within healthcare might not best serve the patient population. We propose that current interpretations of autonomy in healthcare are based on negative accounts of liberty to the detriment of a more relational understanding. We also propose that Kantian philosophy is often applied to the healthcare arena in an inappropriate manner. We draw on the philosophical literature and examples from the self-testing process to support these claims. We conclude by offering an alternative account of autonomy based on the interrelated concepts of relationality, care and responsibility

Hospital nurse staffing models and patient and staff-related outcomes

Background Nurse staffing interventions have been introduced across countries in recent years in response to changing patient requirements, developments in patient care, and shortages of qualified nursing staff. These include changes in skill mix, grade mix or qualification mix, staffing levels, nursing shifts or nurses’ work patterns. Nurse staffing has been closely linked to patient outcomes, organisational outcomes such as costs, and staff-related outcomes. Objectives Our aim was to explore the effect of hospital nurse staffing models on patient and staff-related outcomes. Search methods We searched the following databases from inception through to May 2009: Cochrane/EPOC resources (DARE, CENTRAL, the EPOC Specialised Register), PubMed, EMBASE, CINAHL Plus, CAB Health, Virginia Henderson International Nursing Library, the Joanna Briggs Institute database, the British Library, international theses databases, as well as generic search engines. Selection criteria Randomised control trials, controlled clinical trials, controlled before and after studies and interrupted time series analyses of interventions relating to hospital nurse staffing models. Participants were patients and nursing staff working in hospital settings. We included any objective measure of patient or staff-related outcome. Data collection and analysis Seven reviewers working in pairs independently extracted data from each potentially relevant study and assessed risk of bias. Main results We identified 6,202 studies that were potentially relevant to our review. Following detailed examination of each study, we included 15 studies in the review. Despite the number of studies conducted on this topic, the quality of evidence overall was very limited. We found no evidence that the addition of specialist nurses to nursing staff reduces patient death rates, attendance at the emergency department, or readmission rates, but it is likely to result in shorter patient hospital stays, and reductions in pressure ulcers. The evidence in relation to the impact of replacing Registered Nurses with unqualified nursing assistants on patient outcomes is very limited. However, it is suggested that specialist support staff, such as dietary assistants, may have an important impact on patient outcomes. Self-scheduling and primary nursing may reduce staff turnover. The introduction of team midwifery (versus standard care) may reduce medical procedures in labour and result in a shorter length of stay without compromising maternal or perinatal safety. We found no eligible studies of educational interventions, grade mix interventions, or staffing levels and therefore we are unable to draw conclusions in relation to these interventions. Authors’ conclusions The findings suggest interventions relating to hospital nurse staffing models may improve some patient outcomes, particularly the addition of specialist nursing and specialist support roles to the nursing workforce. Interventions relating to hospital nurse staffing models may also improve staff-related outcomes, particularly the introduction of primary nursing and self scheduling. However, these findings should be treated with extreme caution due to the limited evidence available from the research conducted to date

A review of contemporary work on the ethics of ambient assisted living technologies for people with dementia

Ambient assisted living (AAL) technologies can provide assistance and support to persons with dementia. They might allow them the possibility of living at home for longer whilst maintaining their comfort and security as well as offering a way towards reducing the huge economic and personal costs forecast as the incidence of dementia increases worldwide over coming decades. However, the development, introduction and use of AAL technologies also trigger serious ethical issues. This paper is a systematic literature review of the on-going scholarly debate about these issues. More specifically, we look at the ethical issues involved in research and development (R&D), clinical experimentation, and clinical application of AAL technologies for people with dementia and related stakeholders. In the discussion we focus on: 1) the value of the goals of AAL technologies, 2) the special vulnerability of persons with dementia in their private homes, 3) the complex question of informed consent for the usage of AAL technologies

Ethics of AAL for people with dementia

Ambient assisted living (AAL) technologies can provide assistance and support to vulnerable persons, including those who suffer from dementia. They might allow these persons the possibility of living at home for longer whilst still maintaining their comfort, safety and security. However, the development, introduction and use of AAL technologies also trigger serious ethical issues. This presentation will provide an overview of the ongoing scholarly debate about these issues. We address the question of what ethical issues are involved in the various stages of research and development, clinical experimentation, and clinical application of AAL technologies for people with dementia (PwD) and other related stakeholders? The presentation will focus specifically on the value of the goals of AAL for persons with dementi

Ethics Recommendations for Crisis Translation Settings

This document is a summary public version of the Ethics Recommendations for Crisis Translation Settings produced by some of the INTERACT project team. INTERACT is the International Network in Crisis Translation, a project funded by the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No. 734211. Further information about the project as a whole is available at: https://sites.google.com/view/crisistranslation/hom